Disease Management Update
Volume V, No. 49
April 23, 2009
Dear Healthcare Intelligence Network Client,
Nature versus nurture may still be up for debate across all areas of science, but one thing is for sure: Two studies in this week's Disease Management Update confirm that some conditions really are in your genes. Read on to find out which ones.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
1. Researchers Identify Specific Lung Cancer Susceptibility Gene
University of Cincinnati (UC) cancer cell biologists have identified a distinct gene linked to increased lung cancer susceptibility and development. They say this gene — known as RGS17 — could result in a genetic predisposition to develop lung cancer for people with a strong family history of the disease. With further investigation, researchers believe the gene could be used to identify high-risk patients who may benefit from earlier, more aggressive lung cancer screening.
“Understanding how the RGS17 gene impacts cancer development could change clinical diagnosis and treatment as radically as discovery of the breast cancer genes (BRCA1 and BRCA2) did,” explains Marshall Anderson, Ph.D., who has led the multi-institutional Genetic Epidemiology of Lung Cancer Consortium (GELCC) studying the genetic basis of lung cancer since 1997. “A proven genetic test could help us identify people at risk before the disease progresses.”
For this study, Dr. Anderson and his multi-institutional team collected biological samples from numerous multigenerational families with five or more members who were affected by lung cancer. Through a combination of what is known as “fine mapping” — where genetic information is dissected and analyzed — and genetic association studies, researchers identified RGS17 as a major candidate susceptibility gene for familial lung cancers. Using a genetically altered mouse model, researchers determined that when RGS17 was suppressed, lung tumors shrank, proving the gene was involved in cancer development and must be present for cancer growth.
“What was most interesting is that this same gene was over-expressed in 60 percent of the samples from non-hereditary lung tumors,” explains Anderson. “This suggests that perhaps epigenetic factors may be contributing to abnormal genetic development.”
To learn more about this research, please visit:
2. Disease Management Q&A: Prevention vs. Management
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Marcus Barnes, director of the Richland Care Medical Home Network, Palmetto Health.
Question: What opportunities are there in the ER to educate patients about non-emergent care and the use of the medical home?
Response: Everyone who goes to our ER that qualifies for our program receives a brochure about Richland Care that lists all of the medical homes with their addresses and phone numbers. It also explains the program and discusses different aspects of the program, such as DM. It defines the requirements for Richland Care — you must be uninsured, you must fall under 200 percent of the federal poverty guidelines and you must be a Richland County resident.
For more details on the hospital's role in the medical home, please visit:
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3. HealthSounds Podcast: Patient Assignment into the Medical Home
According to Dr. Anita Murcko, medical director of clinical informatics and provider adoption with the Arizona Health Care Cost Containment System (AHCCCS), patient involvement and collaboration with providers are the keys to any successful medical home assignment — not only understanding what a medical home can provide patients but also how this model of care can empower them.
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4. Researchers Confirm Gene Variants Associated with Adult Leukemia
Researchers found that patients with chronic lymphocytic leukemia (CLL) are more likely to have similar DNA changes or variants in up to six genes, compared to people who do not have the cancer. Two studies demonstrate a genetic basis for the development of CLL, the most common adult leukemia in the United States, says the study's lead investigator and statistical geneticist Susan Slager, Ph.D., an associate professor of biostatistics at the Mayo Clinic.
Using blood samples, investigators performed a genome-wide association study. They combined patients into one group and controls into another and then compared the two groups, looking for differences in genetic variants across the chromosomes. The first analysis of this data focused on the seven single nucleotide polymorphisms (SNPs).
They found that for six of the seven variants examined, CLL patients tended to have the variant more often than patients without the disease. Dr. Slager says these variants are associated with risk of developing the disease, not with prognosis. Dr. Slager estimates the risk of developing the cancer doubles if a person has any of these gene variants, but overall, that absolute risk is still very small. Four out of every 100,000 people develop CLL, so having the variant genes could increase risk to eight out of every 100,000 people.
"Our general theory is that these changes, which a person inherits, combined with environmental risk factors, can predispose a person to developing CLL. The more you understand about these gene variants and how they affect risk, it becomes possible to think about ways to treat or even prevent CLL," said Dr. Slager. "These findings could potentially lead to new treatments or even prevention of CLL, but we have a lot more work to do before we can reach that ultimate goal."
To learn more about this research, please visit:
5. Survey of the Month: Managing Care Transitions Across Sites
Planning a patient's care transitions and closing the gaps in care from one healthcare setting to another can have a significant effect on health outcomes, likelihood of readmission and ER visits, cost to patients, providers and insurers, and the burden on caregivers and family members. Please share your organization's experiences with care transitions by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
To participate in this survey and receive its results, please visit:
6. Medical Homes: Awareness and Early Successes
Early pilots of the PCMH model are making good on their promises of improved outcomes, compliance and care. Get an overview of the medical home concept as well as the highlights from 188 healthcare organization responses to HIN's 2008 non-scientific e-survey on the medical home at work.
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